Caryl cannot move her hands or feet, except for a slight movement of a single toe. We incorporated a sensitive switch into the insole of a slipper in such a way that the switch remains in the same relative position to her foot, even when she is in bed. She can now use her toe to call for help and to activate or adjust an environment control system. Caryl has been using the switch for five years, day and night. Since she has now almost lost the ability to speak, it has become her main communication aid.